Ears: Otitis media, Otits externa, TM perforation, mastoiditis Flashcards
Define otitis media?
Inflammation of the middle ear caused by infection.
Frequently occurring after a viral URTI.
Cause of otitis media?
Bacterial infection after a viral URTI.
Presentation of acute otitis media?
ear pain
fever
conductive hearing loss
otorrhoea (TM perforated)
aural fullness
erythema of TM
irritability
vomiting
systemic illness
Presentation of chronic otitis media?
Benign:
- dry TM perforation without chronic infection
Chronic secretory otitis media (GLUE EAR)
- persistent pain lasting wks
- TM initially looked abnormal and reduced membrane
Chronic suppurative otitis media:
- persistent purulent drainage (perforated TM)
Diagnosis/IVx of otitis media?
Clinical
Management of otitis media and otitis media with effusion?
Otitis media:
- most cases can resolve within 3 days up to a week without abx.
- analgesia (for pain and fever)
- abx (can be given immediately, delayed prescription, or NO abx -depends on pt presentation, significant co-morbidities/systematically unwell or immunocompromised)
1ST LINE: amoxicillin (if allergic, offer clarithromycin; offer erythromycin in pregnant women allergic to penicillin)
Otitis media with effusion:
- refer for audiometry to establish diagnosis and extent of hearing loss.
- resolves without tx within 3 months.
- if problem lasts >3months, then perform GROMMETS (tiny tube inserted into TM to allow fluid to be drained from the middle ear into the ear canal).
Complications otitis media?
Extra-cranial:
- Facial nerve palsy
- Mastoiditis
- Petrositis
- Labrynthtitis
Intra-cranial:
- Meningitis
- Sigmoid sinus thrombosis
- Brain abscess
Define otitis externa?
Inflammation of the external ear canal.
Causes of otitis externa?
Pseudomonas species
Staphylococcus aureus
Presentation of otitis externa?
Ear pain (otalgia)
Pruritus
Hearing loss (if meatus becomes blocked by swelling or discharge)
Minimal discharge
Erythema
Swollen canal
Diagnosis/IVx of otitis externa?
Clinical
May have cultures to determine organism and abx tx.
Management of otitis externa?
Mild/Moderate OE:
- analgesia
- topical drops e.g. combined abx/steroid drops like GENTAMIX, ACETIC ACID
- keep ear dry for 7-10 days
Severe OE (TM not visible):
- ENT referral with oral abx
Complications of otitis externa?
malignant otitis externa
infection can spread to skull base, which can lead to severe pain, nerve palsies.
Define tympanic membrane perforation?
Hole in the TM.
Diagnosis/IVx of tympanic membrane perforation?
Clinical
Otoscope